Physicians writing on KevinMD about the life of the profession: the work itself, the exhaustion, what women physicians are paid and asked to carry, the losses the profession has been slow to name, and who decides how physicians work. Five maintained records draw on this archive: Physician burnout: what physicians say, in their own words, Primary care: what physicians say, in their own words, Women in medicine: what women physicians say, in their own words,, Physician suicide: what physicians say, in their own words, and Physicians and administrators: what physicians say about who runs medicine, in their own words.
Medical errors are a real problem. I won’t deny that.
It was bad enough when the often-quoted Institute of Medicine figure that 98,000 deaths per year in the US are caused by medical errors was in vogue, but now a paper in the Journal of Patient Safety states that adverse medical events result in 210,000 to 400,000 deaths per year and 10 to 20 times those numbers of serious …
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Not all adverse events are preventable
It was a battle. Looking back I don’t think we ever had a chance, but you don’t just give up on a young man in the prime of his life. We had to try. He was my patient.
He was a foreigner, on a gap year in Africa where he was going to learn all sorts of things about conservation and African wildlife. Up until the accident, all had apparently gone …
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I no longer wanted to be a surgeon
I have been a loyal patron of the Karma Hair Salon in New Haven, Conn. for at least the past 15 years. Whenever my hair looks good, it is thanks to Karma and owner Cheryl McMahon’s expert attention to my unruly head (the thickness of my hair — a good problem, I know! — could give a yak envy; and I have more cowlicks than several small countries). If ever my hair doesn’t look …
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Medical training is a product of willful preparation
A piece recently appeared in the New York Times entitled “Who Will Heal the Doctors?”
The piece is written by Donald Borstein and I encourage all to read it. Mr. Bornstein offers a solution to the doctor burnout problem in health care, a course called “The Healers Art,” now being promoted in US medical schools that uses “mindfulness” as his means of creating compassionate, caring doctors as a way forward.
I should say …
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Hostile dependency: The real reason for physician burnout
“Will you charge me?” he asked quietly, between labored breaths. He sat in the hospital bed with his legs over the side in what is known as a “tripod” position — his elbows resting on a nearby stool to prop his chest up as much as possible. His head was hunched over, with his eyes pointed down; clearly he was in agony.
He had been admitted to the hospital two weeks …
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Is it worth it? A question providers need to be asking
Even in its purest form, in the most perfect patient-centered medical home we can create, patients will sometimes need to move beyond the confines of primary care.
Each of us in primary care has a point that we choose not to venture beyond, into the realm of subspecialty medicine where we lack the experience and tools and support to fully implement complete care for patients with these particular problems.
It may be …
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When patients move beyond the medical home
“Sticks and stones can break my bones, but words can never hurt me.” I learned this saying when I came to America, but before that, I learned a different story. A wood cutter got lost in the forest, it was getting dark and cold. He met a bear, who offered him to come to his den. The man entered and said “It stinks in here!” The next day the woodcutter …
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Our words leave the most lasting impression
An excerpt from The Little Boy Inside and Other Stories.
“Hey Altman,” the chief resident says.
We’re in a small group outside a patient’s room. I look up.
“One of the high-fivers needs a central line over on Two North.”
High-fiver. Another code word from the secret language of medicine. High-five means HIV, positive or full-blown AIDS. Probably half the patients on Two North are dying of AIDS. “Got it,” I …
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A medical short story: High five
365.
That’s how many days I’ve been away from our health care system. A year ago was my last day in my old practice. Here’s what I wrote in my journal:
This is it. This is the last day of work at Evans Medical Group. It’s more weird than anything. I am sad to leave the comfort of my old job, but happy to be able to spread my wings and be …
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One year after being away from our health care system
I was spiking a fever.
It was as if someone flipped a light switch inside my body. I could feel the sensation rise through the chest, and trample the dazed contents of my skull. Light, however, was a poor, lazy metaphor. There was no heat, only stimulation.
My belly ached from the repetitive heaving that preceded the fever. I envisioned the sandwich I had eaten that afternoon. I pictured small bacteria crowding …
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Being the kind of doctor that I would want to care for my loved ones
For most of us, we have never experienced the current pandemic of senseless violence that we read about and visualize every day. I challenge you to find a newspaper tomorrow morning, or listen to a news broadcast, that will not report on dark and pernicious inclinations and accomplishments of evil practitioners.
If that challenge is not sufficient, then find an American over the age of 70 to attest that the world …
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Targeting gun owners is an easy target, but off the mark
A 100-year-old woman is brought to the emergency room by a concerned friend because she can no longer get out of bed to get food or go to the bathroom. Other than being unwashed and a little confused, she is fine. Her electrolytes are pristine, her electrocardiogram the definition of normal, her blood count and chest x-ray perfectly mirror the expected physiology for her age. Even her urinalysis is normal. …
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What do we do with the extreme elderly?
In the wake of the horrific floods that struck Colorado recently, many people have debated whether global warming is to blame. The same goes for wildfires that hit that state this summer and for the massive tornado that struck in Oklahoma this spring. In the wake of that tornado, for instance, Senator Sheldon Whitehouse from Rhode Island claimed that Republican opposition to climate change legislation was at fault, for trying …
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Climate change and cancer screening: Leave causation to the experts
Mark Twain once quipped: “Everyone talks about the weather, but nobody does anything about it.”
Is the same true of exercise? Despite a growing, multibillion dollar fitness industry, despite an increase in sales of treadmills, weights, and other home exercise equipment, despite public education campaigns like Let’s Move, eighty percent of Americans — four out of five of us–do not get the recommended amount of cardiovascular and strength training. 41 million Americans belong to …
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What if exercise counseling came in prescription form?
One of the first things I teach medical students is to be aware that they have arrived in a bizarre land. The strange things they see, the disturbed experiences they have, the weird stories they hear, are like noting else in life. I advise students to stay in touch with their feelings, to note what shocks, frightens, or embarrasses them. Remember those emotions now, because as doctors learn their craft …
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Life for patients and their families is so much more than data
As the sixty-something-year-old woman and I shook hands and sat down to get acquainted during her “new patient” visit, she pulled out a small stack of papers and a thick spiral-bound notebook. I glanced at her problem list in the electronic chart: diabetes, obesity, hypertension, anxiety — the usual. She handed me the notebook and a printed Excel spreadsheet with several columns: her medications (a handful), the supplements she takes …
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Trapped between two conflicting professional obligations
I recently saw a sticker on a bus shelter. It was an arrow about 10 inches long and 6 inches wide. It seemed to be pointing to the bus map. “This is Public Health,” it said. The sticker, part of a larger campaign, gave me pause. Sure, a bus stop is public health because it a marker of mass transportation; it symbolizes improved access and decreased pollution from individual cars. Looking …
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Primary care has a marketing problem
